重症胃肠功能障碍中西医结合集束化防治管理优化方案研究

目的 观察3个不同的集束化防治管理方案对重症胃肠功能障碍（急性胃肠损伤）患者关键预后指标的影响,筛选优化的集束化防治管理方案。方法 将180例ICU患者随机分为3组,实施3种不同的治疗方案（方案1是尽早限制性给予肠内营养,以及早期给予肠外营养和中药;方案2是尽早给予合理性肠内营养和中药,3 d后肠内营养不足目标热量60%时加肠外营养;方案3是方案2减去中药）,疗程为7 d,比较3种方案对患者腹腔内压（intra abdominal pressure,IAP）、腹腔灌注压（abdominal perfusion pressure, APP）、胃肠功能、病情严重程度、ICU住院时间、28 d存活率、ICU病死率等的影响。结果 治疗后方案2组患者IAP显著降低,APP显著升高,病情严重程度减轻,28 d存活率显著增高（P<0.05）。结论 方案2能改善重症胃肠功能障碍患者的IAP、APP和病情,提高患者28 d存活率,显著优于方案1和方案3。     

The role of authentic leadership on healthcare Street-Level Bureaucrats’ well-being during the pandemic

This study uses Conservation of Resources Theory, to explain Street-Level Bureaucrats’ (SLBs) workplace behavioural responses to threats to their well-being. We examine whether authentic leadership within street-level organisations positively impacts employee well-being by increasing SLBs’ perception of personal resources, and reducing their perceptions of work harassment. The research design comprises a survey that solicited quantitative and qualitative data from 163 healthcare SLBs working in Australian hospitals during the pandemic in April 2020. Analysis of the means indicates low levels of satisfaction with leadership and low levels of well-being for SLBs. The structural equation modelling findings show that poor leadership is associated with higher levels of work harassment and lower levels of employee well-being. Qualitative data support these findings. As healthcare workers were already listed as over-represented in the stress-related workers compensation statistics, one strategy may be to improve the level of organisational support by upskilling managers in authentic leadership behaviours with the aim of increasing their perception of support so as to increase employee well-being. This will benefit employees and their families, and the community they service.

Points for practitioners

• Street-Level Bureaucrats (SLBs) have been increasingly experiencing the public sector gap (demand outstripping supply of resources) because of the dominance of the austerity-driven managerialist paradigm.
• The recent COVID-19 crisis amplified the severity and impact of the public sector gap causing increased perceptions of work harassment and reductions in SLBs’ well-being.
• However, SLBs with high levels of Psychological Capital had a natural buffer in place to protect their well-being, and as such, they perceived less work harassment and erosion of their well-being.
• The way forward is to complement the austerity-driven managerialist paradigm in management decision-making with authentic leadership behaviours focused on maximising the well-being of SLBs and the public.